The Challenges Physicians Face When Applying for Long Term Disability

As a physician, you spend years learning how to care for sick patients and truly spend your days saving lives. But, if you become unable to work due to injury or illness and want to file for disability benefits yourself, you may be surprised at how complicated the process will be for you.

In this article, we talk about:

  • Why it’s so difficult to file for disability as a Physician
  • How to create a strong administrative file

Why Is It So Difficult  To Get Your Claim Approved As A Physician

Physicians face several challenges when filing for long term disability. Why? Because the insurance company is looking at your case from a financial standpoint. They look at how much money it will cost them to provide you with benefits throughout your disability. The longer it could potentially take you to get back to work, the harder they will make it to get your claim approved.

Residual Benefit Rider

In addition to your regular salary, you may have a rider that helps recover what you have lost during your illness or injury. This would apply to physicians who have their own medical practice instead of working in a hospital. For example: if you are disabled for two years due to a major illness and come back to work, you probably have patients that had to seek medical attention from another provider; this rider will help support you while you rebuild your business and patient list.

Create a Strong Administrative File

Although you, as a medical professional, spend time noting your own patient’s pain levels and completing forms for disability cases, you might find it much different from being on the other side as the patient. A strong administrative file is key to winning a disability claim or case (if it goes to court.) Here are some things that need to be included in your administrative file:

  • Copy of your long term disability policy. Knowing how your insurance company defines “disability” is very important to your claim.
  • Copies of all letters from your insurance company and you to the insurance company.
  • Why you can not perform your job duties (this will require medical documentation).
  • A list of all medical providers that you have seen for this condition and a letter from each provider stating that your condition prevents you from working.
  • Letters that summarize all conversations (by phone or in person) between you and the insurance company representatives, nurses, doctors, and your employer. Send copies to all parties involved in the communication via certified mail as proof it was received.
  • Keep everything chronological so that if your claim is denied, you have a complete record of how your claim was handled.
  • Proof of your monthly earnings.
  • Proof that you are under the care of a physician for your condition.
  • All medical documents from your physician regarding your condition, including but not limited to your official medical file, lab reports, X-ray and MRI reports, physician notes,  and a list of surgeries including surgical reports.

The most common reasons for a claim denial are missing documentation, incorrect information, and missing deadlines. It is very important to provide everything you need for your case in a timely manner. An experienced attorney can help you gather documents and meet your deadlines.

In conclusion,

As a physician, it can be challenging to get a long term disability claim approved due to the substantial cost to the insurance company. They will try to find any reason to deny your claim. By providing strong medical and financial evidence, you can create a solid administrative case file for your disability claim.

Using an experienced disability attorney will help you protect yourself against the insurance company and help you stay organized. The Nick Ortiz Law Firm is based in Florida but represents claimants across the country. Receive a free consultation by calling (888) 321-8131 with no obligation. We can help you evaluate your claim to determine if you will be able to access Long-Term Disability Benefits and how to move forward with the process.


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